| NPI | 1578590394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 001468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT010007L) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2013-10-25 |